Tag Archives: supplements

Why the Pharmacy OTC Section Will Be a Growing Target for Evidence Based Medicine Trolls
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The front store of the pharmacy has traditionally been where the pharmacist and patient relationship grows to a level beyond where it would be with just prescription counseling alone. It affords to pharmacists a selection of products that empowers the lay public to take some sort control of their health in almost any way they choose. With certain selective issues (or perhaps a wider selection in their minds), they can bypass the waiting room of the physician, the poking and prodding, the embarrassing questions, the waiting at the pharmacy counter – all gone with just a wave of the hand from the OTC aisle to the pharmacist peering down to you from his or her stoop in the dispensary.

The general public questions this type of medical treatment very little, partially because of the level of trust that is consistently demonstrated towards pharmacists, or perhaps because most of what is available to choose from in this realm has been virtually unchanged in its ingredient list for decades. In fact I am willing to bet that if I were to walk through the aisles of my neighborhood pharmacy on the day I was born nearly 50 years ago, aside from a few struggles with brand names and a few recognized products that have been discontinued, the ingredient list on most items in the entire store would be much the same as my store today. This brings with it a level of trust in these products by the public, sometimes a false sense.

Back then many of these products were put there in the front store without a whole lot of randomized placebo controlled double blinded/crossover trials (RCT’s) that brought most of the prescription medications to market and back 50 years ago there was little debate as to their effectiveness. The pharmacist recommended it and you took it and it worked. That was that. The path that each product took to land on the shelves of your pharmacy each has a story and history of their own.

There is a growing concern that pharmacists are now selecting items for patients that have little backing scientifically. For example, one of these families of products, known as homeopathic, is one of them. Back 50 years ago you may have even spotted one of these in your neighborhood pharmacy. Now before I go any further I’ll end your guessing of my views of homeopathy: I don’t think it really does much of anything for anybody. For those of you still reading, because you’re in agreement of that last statement, just hold on a second. If we are slamming this mode of treatment because we feel the studies don’t back it or because there is nothing in the actual dosage form, that is fair enough. The supplement aisle is another category that brings about much criticism, and for the record, I have a different belief in this category (just not fanatical in like everyone should have all of them). But as “evidence based” practitioners, in all fairness we need to apply this to the entire store.

Applying our strong standard of evidence to everything else, we look with our magnifying glass at all other products: cough medicines, constipation relief, lice remedies, pain relief selections, antacids and reflux relief meds, skin creams, acne relief, teeth whitening (ok maybe not available in the 60’s), hemorrhoid relief, bug spray, lozenges, lip balm, and lots more. Can you quote or summarize the randomized controlled history for these categories? Perhaps can you find evidence against what you are recommending that product for? Acetaminophen for lower back pain? Cough syrup for someone with a common cold. You can check out a fuller explanation of these categories here .

So getting back to our original claim slammed against us: Why do we sell these items that obviously have some doubt as to their effectiveness? As a pharmacist I am always striving to supply what people want to use for their health as long as it does not harm their health in taking it. Secondly it should be effective. The order of these two is important. My community wanted organic food so that’s what I got in to sell at the pharmacy. Removed 12 feet of magazines and replaced it with organic, gluten free, non gmo. Does it harm them? No. Is it effective for what they are taking it for? Maybe. Maybe not. But it does not harm them.

When Cold FX was going through it’s court case on the claims it was making I voluntarily removed it from my shelves. When the case ruled in their favor I brought it back – much to the delight of my customers who had been asking for it for weeks and months. Is it safe – yes, and is it effective – who the hec knows. I push vaccines, but I also sell Muco Coccinum and stress that you cannot rely on that to prevent the flu or much of anything else. I sell probiotics but screen those with suppressed immune system who cannot safely take them. I ensure that it is used safely first and if it is effective for their gut health, immune health, skin health or mental health then so be it. I try to guide them with the studies I have available to me but first and foremost it must be used safely. That means the product won’t interact with their medication or medical condition or result in them omitting proper established treatment for their condition especially should it be serious or life threatening. No one should be curing cancer or treating their heart disease in this part of the store, but if they have a drug induced lowering of vitamin B12 then I’m their guy. If they are looking to prevent a cold they feel might be coming on with Zinc tablets then great (something I take).

The point of all this is most if not all of new drug research is targeted towards bringing new prescription medication to market, not OTC drugs. While it’s true that some prescription medication may trickle down to OTC status (and thankfully this should have RCT’s to back them up, which is great) not much groundbreaking in the OTC field happens for the most part. Recently I have seen a new product come out for varicose veins and one for vaginal dryness, but for the most part we are stuck with what we have out there, and it’s not an area where we test existing products on new indications, nor do we really go testing a lot of the current indications for existing products that they are sold for (perhaps with a few exceptions). Unfortunately the vitamin/supplement and herbal market is always pushing the boundaries of what science thinks will happen if you take pill A and what an RCT says. What this means is going forward we will be left with an aging pool of products, a number of which have questionable efficacy for the indication they are being sold for and a growing list of products that have the same backup. This pool may have some new additions here and there but the old standards stay around.

Complaining about a select group of these items such as homeopathy is noble, but is kind of two faced when we don’t slam other pharmacists that sell all the other products that have similar lack of actual evidence to back them up. Particularly when the pharmacist is following the law. Being a pharmacist is not being a doctor. We can now prescribe for minor ailments in my area, but the pharmacists today didn’t invent this front store they have available to them. A pharmacist’s recommendation may not always be the same as a doctor’s recommendation, or the same as another’s recommendation, but it should be as safe.

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The Continuum of Evidence Based Medicine
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image002Should Pharmacists be blasted for selling what some call alternative therapies or products that are not “evidence based”? These criticisms can blindside unsuspecting Pharmacists trying to do what they can for their patients regardless of the fact that they are making a profit from it or not. What makes it more difficult is the way in which these criticisms are delivered, especially when delivered in an offensive type of online statement like most opinions are delivered today. It makes one grow thick skin if they wish to continue. As a pharmacist myself, I can reflect on the strong personal feelings we have towards our patients, especially in small community pharmacies. Not that many other health care professionals don’t have this deep feeling of ownership in their patient’s heath, it’s just that as pharmacists, the frequency we see these people is just so much higher, either in person or on the phone. We are one of the most if not the most accessible in their health care team and we answer a lot of questions from them, gladly.

Not only are we seeing these people regularly for health related concerns, but we also see them in passing when they need milk or a greeting card. In short, they feel and we feel like we see them more than some of our own family members sometimes. Couple this with the utter vastness of concerns this patient has and relies on us for.

Quite often these questions fall within the 80% of questions we hear every day. Prescription medications, interactions, side effects, screening what should go on to the doctor and what doesn’t need to, and OTC issues like supplements, cough and cold, pain relief, skin ailments, self treatable infections of all kinds, preventative measures, weight loss advice, and many more. During Med Review interviews, we uncover medical issues not being addressed fully or at all. There are medical issues that are treated in ways that the patient would prefer were treated a different way, either due to current side effects, potential side effects, interactions, or for the simple reason that they just want to be on fewer medications.

Now some may consider this an environment that sets up a scenario for a trap of giving the patient something that hasn’t been proven with studies of thousands and thousands of test subjects in randomized controlled trials. There has been no drug rep with glossy handouts showing graphs and impressive relative change overshadowing a less impressive absolute change in results. Perhaps the pharmacist has no idea of any studies that might exist for anything at their OTC disposal, no numbers needed to treat are at their fingertips (however unimpressive even Rx values for NNT are).

The truth is, a lot of these OTC treatments, even though we are taught them in Pharmacy school as recommended treatments, don’t have all that much in the way of studies to prove they work as I pointed out in a previous blog . This starts the slippery slope of evidence based to non evidence based medicine. This is a continuum rather than a conscious switch. As pharmacists who see the direct results of these recommendations daily, we begin to realize what the term “evidence based” means. It includes the evidence they see every day. Some refer only to large centre, many subject, randomized controlled trials for their definition of this term. Of course this is the basis of our scientific and medical knowledge and has extended lifespan many years. These people however may also recommend some things in what is known as off label use of some medications where the evidence is less plentiful. This is outlined in a recent blog: http://stonespharmasave.com/blog/?p=796 . The statistical method is a gift that helps us weed out chance encounters from truth (http://stonespharmasave.com/blog/?s=statistics ) . Anecdotal evidence can be notoriously prone to incorrect conclusions as it sidesteps statistics in its conclusions. Sometimes we just don’t have these studies available to us and must rely on smaller studies or a physiological basis for a recommendation.

I see this with topical pain compounding all the time. Repeated successful results with a scientific basis and numerous small studies and numerous anecdotal reports drive more recommendations and more feedback. This spreads to physicians that may be skeptical on how these products work. With one patient with a favourable results they become more comfortable in writing again. If a patient tries a prescription medication and it doesn’t work is the Doctor a quack?  Of course not.  Evidence based becomes what you see before you in your little world, regardless of what online bullies think, as long as your first priority is to keep the patient safe.

 

Graham MacKenzie Ph.C.

Stone’s Pharmasave

Baddeck N.S.

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In Case You’ve Just Thrown Out All Of Your Supplements.
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Just in case you are being drawn in by the overwhelming attempt to draw you away from anything that is labeled as a supplement, be weary of one red flag: a claim that “there are no studies showing any effectiveness”. No studies. Not even one. Not a single, solitary inkling of any positive outcome in any way, from any dose or for any medical benefit whatsoever. And this is for a multitude of molecules and a whole list of medical conditions. Imagine the possible permutations. How many combinations of supplements and medical issues are possible? It boggles the mind. And not even one slight benefit from any one of these naturally occurring entities – regardless of what we are eating. The one exception is when a Physician diagnoses a deficiency based on the pooled data of all sick and well patients’ blood levels.  It almost seems impossible to believe.

Equally difficult to believe is the incredible effort that is out there to make people believe this. In social media it is hard to estimate how little of one’s mind is actually firing when we read article after article. What part of the brain that deals with reasoning and logic is getting numbed with this type of activity. Who knows? In any case there are many that take advantage of this and take an unsuspecting reader by the hand, down the garden path and have them walk away with an opinion that they normally wouldn’t.   The same authors, over and over again pen an “evidence based” look at supplements. These articles hand-pick studies, many of them well done, to pad their argument. They may claim that you are falling to the charlatans that are looking to grab your money for the promise that you will live longer. Is it not strange that we have list of people that are always are for or always against supplements? Beyond, rickets, scurvy and beriberi we should be ok. With the exception of B12, Iron, Folic acid, Calcium and maybe thiamin, we have found there isn’t much use in supplementing beyond the normal standard North American Diet (which we all know is stellar to say the least).  Our staggering increase in obesity rates suggest this way of eating has unhealthy issues.   Consistently this is done without even a small open window of the opposing side having any effect at all.

Don’t get me wrong. There are those who exist at the other end of the spectrum as well. The ultra gurus that give supplements a bad name by overselling any supplement to anyone that will buy one. Neither side is being truthful, or helpful to the overall health of the reader. Our scientific method has proven over hundreds of years to be a good system of separating chance from true cause and effect. Although not perfect, it works like a puzzle in that the more pieces we develop from well designed and executed studies, the better an overall picture we get. Some pieces frustrate us because they seem to go against previous pieces. We try to explain everything based on one piece, or a few recently found pieces. This only leads to frustration as we claim to be experts on the more recent studies that seem to completely discount anything earlier. Some find it hard to try and explain studies that don’t gel with their opinion. Rather than trying to explain how it is part of the whole picture, they discount it as a bad study. To further cloud the argument, there are statements of supplements that don’t have what they claim on the label, or contain ingredients that shouldn’t be in the supplement. There are issues of hospitalization, side effects and interactions with supplements – all true, but take away from the argument of the actual supplement doing what it is claimed to do.

Take for example the case of the supplement known as Omega-3. As of late the “unbiased” forum has been quite active in trying to deter anyone from trying it for whatever reason. Well written articles too. And they aren’t really lying for the most part. Well for the most part. Studies are out there that claim Omega 3 isn’t good for heart attack prevention, for cholesterol, but use painfully low levels of omega 3 and claim that omega 3 is useless when no effect is found. This effect is compounded when incorrect titles are put on the study and carried on in the media.

So, to even out the argument, the studies that didn’t exist in these one sided, unbiased, “stay away from your pharmacist trying to sell something they are recommending so it must be bad” stories include these:

 

Omega 3 and cardiac sudden death

Cardiovascular risk and the omega-3 index. von Schacky C, Harris WS. J Cardiovasc Med (Hagerstown) 2007;8 Suppl 1:S46-9.

 

Blood levels of long-chain n-3 fatty acids and the risk of sudden death. Albert CM et al. N Engl J Med 2002;346:1113-1118.

Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty?acids and the risk of primary cardiac arrest. Siscovick DS et al. JAMA 1995;274:1363

 

Omega 3 and cardiovascular disease

http://www.medscape.com/viewarticle/764574

 

Omega 3 and pain relief, inflammation

http://www.ncbi.nlm.nih.gov/pubmed/16531187

http://www.ncbi.nlm.nih.gov/pubmed/9028717

http://advances.nutrition.org/content/2/4/304.full

http://www.ncbi.nlm.nih.gov/pubmed/18362100

http://www.ncbi.nlm.nih.gov/pubmed/16531187

 

Omega 3 and autoimmune

http://www.ncbi.nlm.nih.gov/pubmed/12480795

 

Omega 3 and Child behavior/Spelling in school

.http://pediatrics.aappublications.org/content/115/5/1360

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0043909

http://www.medscape.com/viewarticle/808285#vp_1

.  http://www.ncbi.nlm.nih.gov/pubmed/23056476

 

 

Omega 3 and insulin resistance

http://www.nature.com/srep/2014/141021/srep06697/full/srep06697.html

http://www.ncbi.nlm.nih.gov/pubmed/3320694

http://www.ncbi.nlm.nih.gov/pubmed/18348080

 

Omega 3 and dyslipidemia

 http://www.medscape.com/viewarticle/764574_3

  http://www.medscape.com/viewarticle/789642

 http://www.medscape.com/viewarticle/764574_3

http://www.ncbi.nlm.nih.gov/pubmed/19356403

http://www.ncbi.nlm.nih.gov/pubmed/21684546

 

 Omega 3 and anticoagulant and anti arrhythmic

 http://www.medscape.com/viewarticle/789359

 

 

So keep in mind that if we knew all there was to know about just this one supplement, there wouldn’t be a need for any further studies on it and we would all be experts on it. The truth is somewhere in between those that claim supplements are the thing to replace all conventional medications and everyone needs them all , and those that claim supplements are completely useless. To claim that it is just iron, B12, Calcium, and folic acid are the only necessary supplements makes very little sense given the vast knowledge we have from years of scientific study.

 

Graham MacKenzie, Ph.C.

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Zinc levels and Erectile Dysfunction and Low Libido
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With the erectile dysfunction (ED) market expected to reach 3.4 billion dollars (USD) by 2019, this is a lucrative area to invest in, and not much grabs the attention of a guy watching a commercial during a Monday night football game than the promise to easily cure this problem with one pill as needed.  But is this the answer for everyone?  What causes ED?  For the guy with no apparent risk factors like depression or diabetes, hypothyroidism, injury or stress issues, erectile dysfunction or loss of libido (which don’t necessarily go hand in hand) can be confusing and frustrating for a guy as well as his partner.

What if we look at erectile dysfunction as something that can be addressed as a condition other than a “pill for every ill”.   What if we actually look at a nutrient level that directly correlates to a medical condition and follow the science to give a directive on its recommendation?  Well it turns out taking a simple zinc supplement won’t help 100% of the time, but it certainly helps some of the time.

There are two things that need to be looked at in recommending a supplement for a medical condition: what is the physiology of the medical condition and what is the pharmacology of the supplement you are using.  There then is a search for a link between the two that leads to a tie in with a therapeutic approach.  In some ways this is like a logic course that says A causes B, B causes C therefor A causes C.  We then must apply this to the scientific method and finally the ultimate test: clinical response and safety.  This is often made out to be the gold standard for our typical Rx meds that I dispense every day, but often ridiculed when it crosses the barbed wired “nutraceutical” boarder.  If it is a nutrient then we must be getting the right amount in our food after all right?  Regardless of 1)what the real amount is in the food we eat, not to mention 2)the depletion that may be taking place of that nutrient due to a prescription drug we are taking (an absolute science based cause and effect) – we blindly accept what our food has in it and the level our bodies maintain – this is an incorrect assumption.  In fact it is quite ironic that the anti-nutraceutical court is still hanging onto this assumption when both are established by science.

So what causes erectile dysfunction?  Sometimes it is a circulation problem.  Sometimes it is a low testosterone issue.  Sometimes it is not.  Testosterone (T) supplementation can help ED and low libido in cases of low T and even if there is a normal T level at baseline, ED can be helped.  In cases where thyroid under or overactivity is causing T levels to be less than optimal.  Aging is also a problem as T levels drop after mid 20’s and as adipose tissue increases and aromatase enzyme conversion of T to Estrogen correspondingly increases.  This causes an unfavorable E:T ratio which equates to low T.

When men are given supplemental testosterone it can have positive effects on erectile dysfunction as well as the “grumpy old men” syndrome of low energy, loss of drive, low libido, and loss of endurance as well as “man boobs”.  Zinc has a direct effect on the two main enzyme systems that act on testosterone: conversion of testosterone to estrogen via aromatase and the conversion of testosterone to DHT by 5 alpha reductase.   Zinc blocks the testosterone to estrogen pathway leading to more testosterone.  It turns out that only at really high zinc levels does zinc inhibit the 5 alpha reductase enzyme so when we give mild to moderate zinc supplements, DHT actually increases because there is more testosterone to feed into this pathway.   This actually benefits things because DHT has 2-3 times the times the androgen receptor affinity than testosterone.  In any case, we see an increase of testosterone and androgenic activity from DHT with zinc supplements and whether a guy has low or normal T to begin with, there is a positive change in erectile dysfunction and libido in some men due to the increased androgenic activity and less estrogen pulling in the opposite direction.  Conversely we see testosterone levels drop when a diet is low in Zinc as well as a drop in DHT.  It is important to note that this effect of increased testosterone with zinc supplementation, while well established, does not always lead to an improvement of ED and increased Libido.

Clinically I have seen these results in doses of just 20 mg twice daily.   It is important to note that prolonged zinc supplementation can lead to lowered copper levels so it is not advisable to continue this therapy unless it is in a cyclical nature.  For those on long term zinc there are combination products with Zinc and Copper.   In cases where some prescriptions that lower zinc are given, like acid lowering meds, thiazide diuretics and ACE inhibitors, or in renal dialysis patients, this chronic monitoring of zinc may lead to longer term supplementation.

So, in establishing physiology, pharmacology, clinical results and safety, zinc is a good choice when you look at cost and side effect profile as well as ease of availability and interaction profile with other meds and other medical conditions.  Having said all of this, there is no bulletproof evidence out there guaranteeing that increasing your zinc consumption either in food or via a supplement will improve ED or increase libido.  Even if a patient experiences an increase in testosterone from such a supplementation, this is not a certain gateway to resolution of theses symptoms as there is more to it than just one hormone level.  However for those that are experiencing problems in these areas, it is certainly worth a try for them.  The patient should be mindful however that supplements should be treated like any other medication and trying to increase your testosterone shouldn’t be done without consultation with your doctor and pharmacist.  You should also check for any interactions with any meds or medical conditions before trying any supplement as well.

 

Khedun SM1, Naicker T, Maharaj B. Zinc, hydrochlorothiazide and sexual dysfunction. Cent Afr J Med. 1995 Oct;41(10):312-5.

 

Prasad AS1, Mantzoros CS, Beck FW, Hess JW, Brewer GJ Zinc status and serum testosterone levels of healthy adults. Nutrition. 1996 May;12(5):344-8

 

Chang CS1, Choi JB, Kim HJ, Park SB Correlation between serum testosterone level and concentrations of copper and zinc in hair tissue.  Biol Trace Elem Res. 2011 Dec;144(1-3):264-71.

 

Jalali GR1, Roozbeh J, Mohammadzadeh A, Sharifian M, Sagheb MM, Hamidian Jahromi A, Shabani S, Ghaffarpasand F, Afshariani R.  Impact of oral zinc therapy on the level of sex hormones in male patients on hemodialysis.  Ren Fail. 2010 May;32(4):417-9.

 

Michael F. Leitzmann, Meir J. Stampfer, Kana Wu, Graham A. Colditz, Walter C. Willett and Edward L. Giovannucci Zinc Supplement Use and Risk of Prostate Cancer  journal of the National Cancer Institute. Volume 95 , Issue 13 pp 1004-1007

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What causes “expensive urine”? Vitamins or the Prescription drugs that deplete them?
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testpostPerhaps one of the biggest blanket statements against the nutraceutical/supplement movement is the claim that “vitamin and mineral supplements do nothing more than cause expensive urine”.  This is a claim most of us have heard before and certainly for busy pharmacists, physicians and the public in general that may not have the time to fully research the topic, a claim that might be true.  After all, we can’t be experts on everything and it’s always easier to grab a catchy headline and adopt it as our “go to” statement and move on to the next topic that may come up in counselling.

Even as a pharmacist, keeping up to date on all pharmacy topics, changes in position statements, and heaven forbid – reading a readily available study or a number of studies on just one topic is a daunting task.  Our path is made simple for us when an “expert group” comes out with a statement on the best practice guideline for anything, even if there are flaws with the statement and how they mesh with current studies.  But who is it that makes these recommendations on supplements?  No one really.  Here is an area where self-education is key.

As a disclaimer, I am one that believes in the value of carefully selected supplements and that each individual deserves a review of what their needs are for individual supplements.  This was taught to me in my Pharmacy Degree in University and I have continued to follow up on it for over 20 years since then.  Claims that I am out for a quick buck have rolled off my back a long time ago and are as baseless as a claim that I am out for a quick buck because I sell prescription medication.

In the same University level I was introduced to the fact that many if not all prescription medications can deplete us of specific nutrients, a fact that is often lost on a busy pharmacist’s thought process when filling 200 prescriptions a shift.  After all, isn’t it more important that we make sure the prescription is paid for fully by the third party plan?  Or that we comb through a profile for interactions so we don’t end up harming the patient or on a national “news” program uncovering how we missed something and caused harm to the patient?  Or maybe we are so focused on counseling the patient to make sure our job is done to the letter.  Maybe we are preoccupied with a chocolate bunny getting stolen in aisle three?  Granted these uncover important parts of a pharmacist’s job but it is just as important to review with a patient and make them aware of long term effects of the medication they are taking.  This includes nutrient depletions from taking prescription medications.  It turns out some of the side effects of long term meds may be a result of these depletions.  Some may be weary of being accused of gouging a customer for extra money when they pick up their prescription when they suggest this but there is sound science to back you up.

As always it is important to get as many nutrients from food as possible in the diet.  Due to variations in end product vitamin and mineral content due to growing conditions, food processing, storage and cooking, the final intake of these nutrients is a variable that can make it difficult to get sufficient replenishment from food alone, particularly when a depleting agent is being administered concurrently.

Some documented examples of these depletions include:

1)  Recommendation of a probiotic in a patient on an antibiotic or several rounds of antibiotics.  I have seen diarrhea cured with the administration of a good quality probiotic.  Our health begins in the gut and probiotics are the first line of protection on the lining of this organ system.  Aside from this, antibiotics have a depleting effect on a long list of multivitamin ingredients and those that have taken several antibiotics over a few years may do well to supplement even short term to replenish these stocks.

2)   Oral contraceptives – how many of your patients are on these? Of these patients how is their diet?  Magnesium depletion that can lead to thrombosis, breast cancer protecting selenium that can be depleted, folate depletion leading to neural tube defects in newborns either in OC failure or when a woman comes off an OC,  B2 depletion that has been shown to cause headaches – a side effect we often see from OC’s, B6 depletion that can lead to decreased serotonin and altered mood in OC users, not to mention B12, vitamin C, E and zinc depletion are all shown to be significant in OC users.  http://www.europeanreview.org/wp/wp-content/uploads/1804-1813.pdf

3)  Statins – perhaps one of the most famous depletion in this group of drugs is the CoenzymeQ10.  This depletion was so recognized in early trials of the statins a patent was actually given for a combination statin and CoQ10 product, which was never used.  http://www.functionalmedicineuniversity.com/statin-CoQ10.pdf  Endothelial stabilization and a decrease in the inflammatory cascade are shown with higher levels of CoQ10 and this is precisely what elevated cholesterol levels cannot use in a plaque formation.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671099/     http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176102/    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271709/

The presence of the muscle pain in statin use has also been tied in with CoQ10.  More studies would be helpful in completely putting this to rest as would vitamin D level depletion statins and muscle pain connection.

There are many other examples of nutrient depletion from medication use.  These include ACE inhibitors, Chemo drugs, anticonvulsants, NSAIDS, antidepressants, antipsychotics and many more.  A more complete list is included on our website to give a starting point for recommendations at http://www.stonespharmasave.com/drug_depletions.html

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How Long Can a Human Live? Telomeres & The Effect of Money on Life Expectancy
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The World Health Organization has released statistics that relate the most common causes of death in relation to overall income for a country.  Believe it or not, HIV/AIDS is the second leading cause of death among low income countries.  Also in these countries, almost 1/2 of the deaths in children under the age of five occurred within the first 28 days of birth.  Causes of death for these infants are taken for granted in western societies, diarrhea, pneumonia and malaria are major causes of death in parts of the world with the lowest income.  And let’s not forget tuberculosis, a disease that is making a comeback due to the length of time required to treat, not to mention the cost. Fully 1/3 of all deaths in low income countries are from these above mentioned causes.  To add to these deaths is the increased percentage of maternal deaths – moms that pass away during childbirth, because of pregnancy related medical issues or medical problems related to the birth of their child after birth.  Premature births are also a major contributor to death in this population.

However, in contrast to the infectious diseases mentioned above, the higher income countries death rates showed that 87% of deaths were non infectious disease related deaths. 70% of people in high income countries die at the age of 70 or higher in contrast to 20% in low income countries.  What are we dying from in higher income countries?  Ischemic Heart Disease and Stroke, collectively known as cardiovascular disease.  Only 1 in 100 deaths is among the age group of 15 years old and younger in western societies, compared to 4 in 10 for lower income countries.

What does this all tell us?  Well people in these low income countries still die of heart disease and stroke.  We just live longer in higher income countries because of the healthcare and medications available that allow us to fight these diseases.  Certainly medications have drastically lowered the main causes of death here that are common for the low income countries like communicable diseases and childhood deaths.  We may die of accidental causes more in western type societies.  As a pharmacist I can tell you if I take away the number of prescriptions that are for infection, cardiovascular disease medications amount for a significant proportion of medications.   Psychoactive meds perhaps second, acid lowering meds close behind (which brings to light the issue of gastric cancer in western societies as compared to lower income countries).  As I have blogged before, the medications are only a small part of it, as is evidenced in the difference in life expectancy between the US and Canada.  Life expectancy in Canada is notably higher than the US even though we have the same medications available, just different healthcare models.  Healthcare in Canada is free for the most part except for medications.  I think the main reason is diet, as many states have similar life expectancy to Canada except for the Southern states, which have quite a different diet than the rest of the country and skew that country’s total life expectancy to a lower number.

So how long can we expect to live as humans?  Absolutely one of the greatest achievements of the 20th century was the increase in lifespan for those on the planet.  We have extended lifespan by nearly 40% in the last century.  Definitely getting a human past the age of 15 is a huge hurdle in extending this timeline.  In the next 50 years, the percent growth in our population is expected to be exponential in the 85 and older group compared to those that are younger.  All of the above mentioned factors of medication, research, healthcare models, and so on have certainly helped and perhaps knowledge of nutrition, but food has been the downfall of how we die.  Not only cancer but other obesity related issues can be chalked up to our diet in some way or another.  Exposure to other toxins daily due to our lifestyle has drastically changed in the last 60 years as well.  Our lifespan has increased but our disease state that ends our life has changed.   Seemingly, when someone moves from Rural China to North America, the reason for dying changes within a generation or two.

The timing of our decline and ultimate death is encoded deep in our genes.  I am always quick to argue that your genes can be controlled to prevent disease but ultimately there is something more powerful going on that we can’t yet override.  There seems to be a clock or sensor in our genes that says, “time to wind down”, or “you are no longer able to contribute to the reproduction of the species”.  These genes are interfered with less in lower income countries with less availability to medication or healthcare.  Diet, exercise and lifestyle are free to impose their natural forces on DNA unhindered by medicine.  Even if we avoid disease, if that is possible, we still can’t live forever.  Why is that?

The telomere theory of agin does a good job to explain this.  Telomeres are located at the end of our DNA strands.  As our cells divide, the DNA replicates so each new cell has its own DNA.  Telomeres are disposable caps at the DNA strands.  As DNA divides there is always a point where the division of DNA occurs before the actual end of the DNA strand.  Small amounts get clipped at the end with each cell division.  Telomeres are the buffers that contain “throw away” pieces with each cell division.  Now imagine how much of this finite buffer is left when you are 80 compared to 20 years old.  At that point we start clipping useable pieces of DNA with each cell division after using up the telomere buffer during your lifetime.  At that point we actually have defences to stop division of that cell so mutant cells or cancer won’t develop.  The bad side is that we don’t duplicate a cell like that anymore and it dies.  Antiaging medicine has focused on keeping the length of these telomers as lengthy as possible to maintain healthy cell division.

This is an over simplified method of aging.  How do we prevent the shortening of telomeres and therefore heart disease, cartilage loss?  Antioxidant support, astralgus, B,D and C vitamin and mineral support, a good diet, organic food, lack of stress, and as much a we hear that multivitamins are useless, a study has shown that telomeres are on average 5% longer in those that take multivitamins as opposed to those that don’t.  Dropping inflammation with omega 3 is also helpful and green tea, curcumin, quercetin, resveratrol, mixed tocopherols (vitamin E mix) also have shown promise.

So we can debate the effect of money on cause of death for a given country, but in the end, even if we prevent disease, we aren’t living forever.  Keeping the degradation of telomeres at bay not only prevents longterm disease, but extends lifespan even more.  Don’t agree with these nutrition recommendations? Just start by eating better and exercise more.

 

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Are you fighting cancer daily?
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With billions of dollars spent on research over the last four decades, we still are faced with the shadow of cancer striking at any time.  All of us have cancer cells, it’s how well our body deals with these cells that determine our chance of having a diagnosis.  How is it that those persons that we determine as “completely unhealthy” live a long life and escape this disease, while those that are young and eat healthy and exercise regularly can be afflicted?  Things ultimately happen at the DNA level in the cell.  This is where cell division happens.  Epigenetics, the science of how factors external to the nucleus of the cell greatly influence the life of that cell and ultimately, the life of that organism, is the one big argument to the feeling that cancer is determined by a genetic test. Genetics can more easily predispose you to something happening, but epigenetics is the way out of that pathway.  What can you do to influence your genes to avoid duplicating wrong and developing to cancer?

1) Hypocortisolism – If you live in North America today, you have chronic stress knocking on your door.  Bills, relationships, jobs, money, family, illness, travel, bereavement, … If you don’t experience stress then you have a gift.  Even those with seemingly normal lives can become used to chronic stress and go years without an outward sign to others from abnormal cortisol.  Low cortisol has many reasons.  Acute stress has benefits in an evolutionary way, but chronic stress can result in someone going from high to low cortisol in a chronic way.  Colorectal, Breast and ovarian cancer have shown a correlation to hypocortisol states as are the outcomes of these diseases. I rarely see “normal” cortisol levels when we test; a sign how long people wait to get help.  Adrenal supplementation is consistently one of the most successful OTC therapies I see used.

2)Diet & Exercise – In the end, your health comes down to how you eat and how much you move.  There has been quite a debate as of late concerning whether you should eat wheat, how much carbs you should eat (if any) or whatever.  Any recommendation is open to debate.  Mine is avoid processed food as much as possible and avoid as many contaminants as possible (herbicides, pesticides, fertilizers, heavy metals, etc.) – to me this means organic as much as possible; avoid any foods that are known to cause sensitivity in an individual and therefore decrease systemic inflammation;  fill 1/2 your plate with vegetables; chew your food; consume healthy fats (don’t cook with olive oil at high heat); eat variety; increase fiber.

3)Sleep – There is an association between melatonin and various cancer types, most recently in the news is prostate cancer.  The higher the level, the lower the risk.  Melatonin aside, the effect sleep has on cancer incidence is well studied.  Night shift workers often show higher breast cancer rates than women who sleep normal hours.  These people have less melatonin than non shift workers.    Not only is the incidence of breast cancer higher, but the death rate is typically higher from cancer in these women.  It is thought that people with sleep problems have issues with the above mentioned cortisol during the night that contributes to cancer incidence.

4) Supplements – contrary to recent reports in the media, supplements are valuable to your health.  A healthy body can stay healthy for the most part by getting nutrients from food.  A body that is damaged or in a negative situation will find it difficult to get back to normal just from food alone.  Preventative medicine uses doses of nutrients that are difficult to get from food alone.  Vitamin D has shown anti-tumor effects in vitro and higher vitamin D intake has been correlated with a lower incidence of many cancers.  It also helps with pain relief and disease progression.  Vitamin E is a supplement that has received bad press for years.  Most likely your supplement has only alpha-tocopherol.  To be healthy and effective, all forms of vitamin E must be taken in one supplement (alpha, beta, gamma and delta-tocopherol).  Prostate cancer has been shown to be reduced with this supplement. Vitamin C has been repeatedly tested and shown to help prevent cancer and lead to more favorable outcomes in patients with existing cancer.  These doses are often IV and deal with 10 or more grams daily.  Some have dealt with doses of 100 g daily.  Selenium is also helpful by enhancing the immune system function and acts as an antioxidant.  Doses used were in the 200 microgram per day range.  Melatonin has shown to increase the  survival times and demonstrated anticancer effects.  Doses used are 10-50 mg/day in the evening).

Granted, these are not complicated steps for the most part.  DNA’s resilience has a good side in that it can lead the cell to replicate countless times without error.  Unfortunately this is the downfall of the organism when errors occur in cell duplication and the mistake becomes engrained in the DNA.   Without proper immune system function to clear a faulty cell or cells from the organism, then everyone hangs onto these cells. Maintain your immune system and keep the environment surrounding your DNA supportive to the next cell duplication.

 

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Fighting #Cancer with Nutrition and #Nutraceuticals @grahamcmackenzi
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Cancer prevention is just as important as cancer treatment.  Perhaps you have a family history, maybe you have a long term exposure to a known carcinogen, or you’ve done genetic testing to determine risk, maybe you are just wondering if you will randomly be diagnosed with this terrible disease next year, or the year after that.  We are not destined to get cancer.  We can drastically increase the odds of getting cancer based on nutrition and lifestyle choices.

What do I recommend?  Although the exact details depend on the patient and the type of cancer, many recommendations are similar.

1) VITAMIN D.  What can’t I say about this vitamin?  Recent studies have shown a 50% decrease in certain cancers (like breast cancer) when a blood level of 50 ng/ml were maintained.  It is impossible to guess your level of vitamin D so get it checked!  How much should be taken, for most people in my area of the world in Canada I recommend a minimum of 2000 iu per day.  To get to where they need to be, they may need 4000 or 10,000 or more.  Some feel this is overdosing but sunbathing for 30 minutes gives you more than this.

2)FISH OIL.  Just as above, high quality fish oil (EPA / DHA) that gives you omega-3 daily not only helps to prevent cancer but has been shown to increase weight gain in cancer patients and improve outcomes.  Patients typically take 4-12g daily.

3)METABOLIC CLEANSE.  Whether or not you agree with the concept of a cleanse, your body needs all of the ability it can muster to fight off or prevent cancer.  GI/liver/kidney detox will open up your body to operating at fuller capacity.  There are various cleanses available.  Some gear towards the stress and damage of the mitochondria that produce the energy in your cells.  Feeding the body the right energy from sources like Coconut oil can benefit.  Along the mitochondrial lines, glutathione is a key supplement for energy production although its oral absorption is poor; IV is better but it still needs to be broken down into its constituents and reassembled in the cell.  Eating Cysteine rich foods, taking SAMe, N-acetyl-cysteine (NAC), whey protein, alpha lipoic acid, milk thistle and melatonin can all replenish glutathione levels and are all good supplements especially in the cancer patient experiencing side effects from their chemotherapy. L-Carnitine and acetyl-L-Carnitine help the mitochondria transport fatty acids like the ones in Coconut oil.

4)Vitamin E.  Although I often recommend supplements for various conditions, I tend to lean towards dietary sources of this vitamin.  Because of the different isomers vitamin E comes in, it gives a better spread when eaten unless your supplement contains them all.  It also have the effect of reducing tumor growth.

5)Green Tea/EGCG-This is another supplement that shows promise in various types of cancer and cancer prevention and has a good safety profile.

6)Overall Diet- Most of us would not be surprised with the following suggestions.  Obesity increased inflammation and increases the risk of several types of cancer.  Maintaining a proper BMI and a fat percent under 25% are recommended.  As studies emerge, the consumption of red meat (especially well cooked at high temps) appears to be associated with increased rates of some cancers.  Processed meat consumption is also not great for cancer prognosis.  Increased fiber decreases the risk of several cancers.  Whole food consumption from fruits and vegetables is shown to reduce the risk of cancer.  We understand that eating this is difficult for many people big and small, so recently we began recommending Juice Plus+ brand of whole food supplements to ensure our patients were getting their intake of fruits and vegetables.

7) Exercise!!!!!

There are many other recommendations, involving vitamin C, zinc, selenium, probiotics, vitamin A, magnesium and others that we like to tailor to each individual and their prevention and complimentary treatment regimens.

Take care

References

Gaby, Alan,R MD, Nutritional Medicine., Fritz Perlberg Publishing 2011

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Natural help for High Blood Pressure
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Has your doctor been warning you that your blood pressure is creeping upwards and that your future may include medication to bring it down?  Are you having problems with erratic blood pressure or difficulty in bringing down your blood pressure with existing prescription therapy?  Your vascular and cardiac health are important to us.  Ask us about supplemental help for existing drug therapy or initial therapy for uncomplicated elevated blood pressure (140/90 or below with no other health issues).  It may be worth a try before your next doctor’s visit.

-Keeping physically active and eating a balanced diet that is low in salt

-Hydrolyzed Whey Protein and Soy Bean Protein

-Vitamin C

-Coconut oil, Olive oil and other Monosaturated Oils

-Omega-3 fatty acids (EPA/DHA)

-Magnesium

-Hawthorn berry

-Vitamin B6 (taken with a B complex)

-R-alpha-lipoic acid with biotin

-pycnogenol

-celery or celery seed extract

-Other supplements containing l-argenine, carnitine, taurine, CoQ10, lycopene, NAC.

If you have existing heart issues or severe high blood pressure or are unsure as to whether you should be self treating elevated blood pressure on your own, let us know.  Self treatment of elevated blood pressure is not appropriate when higher than 140/90 or when combined with other conditions that affect the circulatory system, such as existing cardiac disease, risk of stroke, and circulatory problems. Prescription medications are important to bring down high blood pressure.  Natural supplements given in therapeutic doses are a great way to help.  Always ask your pharmacist before initiating any new therapy.

 

 

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